1238 Beach Avenue TREE18-0038 (Void)TREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
INSTRUCTIONS
1. Complete and sign this application.
2. Attach required exhibits as listed on application checklist.
3. Contact the Community Development Department if you have questions.
4. Submit the completed application and all required exhibits, along with
application fees to the Permits Desk at Atlantic Beach City Hall.
SITE INFORMATION
FOR INTERNAL OFFICE USE ONLY
PERMIT #'W l Fi'c�os�i
® Legacy Tree $ 25.00
❑ Single -/Two -Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional / Other Non -Residential $250.00
ADDRESS Q-3 D L'41(aj�jpt4Vt
SUBDIVISION U iA BLOCK# Uv
APPLICANT INFORMATION
RE#
LOT #
NAME / ( EMAIL �
ADDRESS la3K- ` CITY V STATE a ZIP C DE 3
PHONE # -717 391- CELL # :;417 ? � J, [N.@WNER ❑ LEGAL AUTHORIZED AGENT
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
Additional information may be required, depending upon circumstances unique to individual applications
EXHIBIT A (Option 1) - PROOF OF OWNERSHIP: Copy of Warranty Deed that verifies record of owner (Clerk of Courts)
❑ EXHIBIT A (Option 2) - LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner
❑� EXHIBIT B - TREE INVENTORY and TREE PROTECTION PLAN
❑ EXHIBIT C -TREE MITIGATION WORKSHEET
0 EXHIBIT D -TREE MITIGATION PLAN
SITE PREPARATION CHECKLIST
PLEASE PREPARE YOUR SITE AS FOLLOWS:
❑ Mark all trees identified for removal with RED or ORANGE flagging, paint or tape
❑ Mark all trees identified for preservation with BLUE or GREEN flagging, pain or tape
❑ Mark property corners with stakes or paint
❑ Barricade all trees to be preserved on the property at the dripline
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO COMPLY WITH ALL
PROVISIONS OF CHAPTER 23 (PROTECTION OF TREES AND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDINANCE T E CITY OF ATLANTIC BEACH.
G TU
OF (CANT PRINT OR TYPE NAM E
02 TREE REMOVAL PERMITAPPLICATION 03.01.2018
EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
City of Atlantic Beach
�. Community Development Department
800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
TREE INVENTORY -Please sketch an inventory in the area below or attach a site plan showing all existing trees on the property below
that are 3" diameter at breast height (dbh) and greater. Please complete the following:
• Note the location of all trees to be removed with an "X" • Note the location of all trees to be preserved with"[ )"
• Number all trees and list on EXHIBIT C: Tree Worksheet • Show all existing and/or proposed buildings
TREE PROTECTION PLAN- (If you are doing construction on the site) -Please sketch and identify in the area below or on a copy of a
certified tree survey the location of the protective barricades to be installed prior to construction. Section 23-32(c) requires protective
barricades to be installed around every tree or group of trees to be preserved.
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PREPARED BY: SCALE: 1 SQUARE=
02 TREE REMOVAL - EXHIBIT B: Tree Inventory and Protection Plan 03.01.2018
0yLyEXHIBIT C: TREE MITIGATION WORKSHEET
City of Atlantic Beach
s Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
!tit (P) 904-247-5800
List the species and diameter at breast height (dbh) of all trees identified on EXHIBIT B
FOR INTERNAL OFFICE USE ONLY
PERMIT #
ID
DBH
SPECIES
removing
preserving
replOacing
COMMENTS (for use by City Staff
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5
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15
16
17
18
19
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1 02 TREE REMOVAL -EXHIBIT C. Tree Mitigation Worksheet 03.01.2018 1
�iyLyr�J, EXHIBIT D: TREE MITIGATION PLAN
�s City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
Please identify the location, species and size (caliper inches) of ALL trees to be planted for mitigation credit in the area below or on a
separate site plan. Please include existing and/or proposed buildings and any street names for reference points.
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02 TREE REMOVAL -EXHIBIT D: Tree Mitigation Plan 03.01.2018
Date Paid: Monday, October 29, 2018
Paid By: MOYER RICK ANTHONY
Cashier: BA
Pay Method: CHECK 355
00.0,
Printed: Monday, October 29, 2018 10:18 AM 1 of 1 t'
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